Equity of access to pathological diagnosis and bronchoscopy for lung cancer in Aotearoa New Zealand

Background: Maori are less likely to survive their lung cancer once diagnosed, but it remains unclear whether this is partially driven by poorer access to best-practice diagnostic services. Methods: We examined all lung cancer registrations in Aotearoa New Zealand between 2007-2019 (n=27,869) linked to national administrative health datasets and further stratified by ethnicity, tumour type and stage of disease. Using descriptive and regression analyses, we compared ethnic groups in terms of the basis of diagnosis (e.g., histology, cytology), receipt of bronchoscopy and travel distance and time to access bronchoscopy. Results: We found no differences in access to a pathological diagnosis between ethnic groups regardless of cancer type or stage. We found that M & amacr;ori within the cohort were marginally more likely to access bronchoscopy than the majority European group; however, we also found that M & amacr;ori had lower odds of living close to the location of their bronchoscopy, and correspondingly higher odds of living 100-200km (adjusted odds ratio [adj. OR] 1.46, 95% confidence interval [CI] 1.26-1.69) or more than 200km away (1.36, 95% CI 1.15-1.61) than Europeans. Conclusion: Interventions that aim to further support M & amacr;ori to overcome the systematic and cumulative disadvantages in access to cancer care should be broadly supported and resourced.